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1/18

On duty (ER Stage) :

Maisarah, Asti, Bagus

Emergency Room Case ReportFebruary 4th-9th 2013


2/18

Minor surgey : 3

Urology :1

Digestive : 3

Ortopedics :2

Neurosurgery : 0

Pediatric Surgery : 0

Oncology :0

Vascular and Cardiothoracic :0

Plastic Surgery :0

Total patients : 9

Reported patients : 1


3/18

Mr. Yamani/15 yo/Admitted to ER on

February, 7th 2013 at 11.00 am/Crush

injury a/r digiti IV-V manus dextra


4/18

Chief complaint : crushed finger

The patient complained that his third, fourth and fifth finger on

the right hand was crushed because its minced in a bread

machine. The incident happened approximately 15 minutes

before the admission. On the fourth and fifth finger, skin,

muscle, and bone was crushed to pieces. Patient loss hissensation on the crushed part but sensation of pain can be

felt on the border betwen crushed part and not crushed part.

On third finger there is an open wound on the edge of finger.

they keep on bleeding. Before admission, patient put apressure on his injury with a cloth, spilled with stone oil.

The patient then sent to Ulin general hospital.


5/18

Clear, snoring (-), gargling (-)

A Clear, RR=20/min, simmetric respiratory

movement, simmetric VBS

B BP: 120/80 mmhg, Pulse rate: 92 x/m

regular, strong pulsation

C GCS E4V5M6, round and simmetric

pupils , diameter (3mm/3mm), light

reflexes (+/+)

D


6/18

A -

M -

P -

L 4 hours before

admission

E Bread factory


7/18

Eye : anemic conjunctivae (-/-), icteric sclerae (-/-), periorbitalhematoma (-/-)

Mouth : Wet mucosa, cyanosis (-)

Neck : increase of JVP (-)

Head/Neck

I : Simmetric respiratory movement, retraction (-)

P : Simmetric VF

P : Sonor in all lung field

A : Simmetric VBS, Rh (-/-), Wh (-/-)

Thorax

I : Flat, hematoma (-)

A : Normal bowel sound P : H/L/M not palpable, tenderness (-), mass (-) P : Tympanic in all quadrants

Abdomen

Warm periphers, no edema in inferior extremities

Crush wound on fourth and fifth finger on the right hand

Open wound on third finger on the right hand

Extremities


8/18

Region of third digiti

manus dextra

Look:Open wound, 1 cm

x 1 cm with soft

tissue loss, nailloss,

irregular edge,

dirty, bone expose,edema (-),

Bleeding (+)


9/18

Region of third

digiti manus

dextra Feel:

Pain (+), Loss

of sensation (-),crepitation (-)

Region of third

digiti manus

dextra Move:

Active ROM:

Free

Passive ROM:

Free


10/18

Region of fourth digiti

manus dextra

Look:crush wound,

length: app. 5 cm

with crushed bone,muscle, skin,

Up to phalangx

proximal,

irregular edge,dirty,

edema (-),

Bleeding (+)


11/18

Region of fourth

digiti manus dextraFeel:

Pain (+),

Loss of

sensation (+)

Region of fourth

digiti manus dextra

Move:Active ROM:

limited

Passive ROM:limited


12/18

Region of fifth digiti

manus dextra

Look:crush wound,

length: app. 5 cm

with crushed bone,muscle, skin,

Up to phalangx

proximal,

irregular edge,

dirty,

edema (-),

Bleeding (+)


13/18

Continued


manus dextra

Feel:

Pain (+),

Loss of

sensation (+)


manus dextra

Move:Active ROM:

limited

Passive ROM:limited


14/18


15/18

Hb : 12,5 g/dl

Leu : 7,8 thousand/ul

Eri : 4,76 million/ul

Ht : 40,0 %

Tr : 344.000

PT/APTT : 13,3/27,1

BSS : 97 mg/dlUr : 29 mg/dl

Cr : 0,72 mg/dl

SGOT : 17 U/l

SGPT : 17 U/l

Na/K/Cl: 143,5/4,03/106,6


16/18

Crush injury a/r digiti IV-V manus dextra


17/18

Management :

Referred to Orthopedic Consultant (Resident) :

Dressing

Emergency surgery : Repair Stump

HospitalizationAntibiotic, Analgetic, H2blocker


18/18

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